RESUMEN

The "small-for-dates" babies are not a single entity but a heterogenous group. The condition has been attributed to many possible causes and mechanisms that many induce "poor fetal growth" in utero. Poor intrauterine fetal growth (P.I.F.G.) has been recognized to occur in many circumstances, can begin at various stages of pregnancy and be caused by several different factors. It was assessed that a reduction in fetal growth support can produce irreversible quantitative and qualitative deficiencies in the organs of the fetus and these deficiencies can play a significant role in perinatal pathology. The recognition of these forms at the right time, the knowledge of the criteria for evaluating their severity and their evolution during intrauterine life would seem to be preferable. Therefore, it is essential to define the various forms of P.I.F.G. during pregnancy to give them names, to define the patterns of P.I.F.G., which are seen in various maternal and/or fetal diseases or conditions, so that they can easily be referred to and understood by everyone. That is the purpose of the proposed etiologic and clinical classification of P.I.F.G.

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The experiences hitherto made and the clinical reports speak for a causal connection between chronic alcohol abuse of pregnant women and an intrauterine fetal lesion, the prognosis of which is not favourable. The feature of the alcohol embryopathy mainly distinguishes itself by prenatal and postnatal disturbances of growth, cerebral lesions, signs of the craniofacial dysmorphism, dysmorphous signs at the extremities and at the skeleton, cardiovascular dysplasias, anomalies at the genitals as well as abnormal furrows of the fingers and atypical dermatoglyphes. Occurrence and degree of severity of the malformation syndrome depend on the quantity of alcohol taken, the duration of the influence of alcohol, the phase of the disease of the mother, the moment of the alcohol exposition during pregnancy and a genetically conditioned different activity of the alcohol hydrogenase. The prophylaxis of the alcohol embryopathy consists in the influence on drinking manners usage as well as in the recommendation of an interruption of pregnancy in severe cases of chronic alcoholism.

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Experience so far accumulated as well as clinical reports are likely to suggest the existence of a causal relationship between chronic abuse of alcohol by pregnant women and intrauterine fetal damage, usually with poor prognosis. The pathological pattern of alcoholic embryopathy is characterised primarily by inhibition of prenatal and postnatal growth, cerebral damage, cranio-facial, skeletal, and extremity dysmorphism, cardiovascular dysplasia, abnormality of genital organs and of palmar crease, and atypical dermatoglyphics. Incidence and severity of malformations were found to depend on quantitative alcohol consumption, length of exposure to alcohol, phase of the mother's alcohol disease at the time of pregnancy, timing of exposure to alcohol during pregnancy, and gentically differentiated activities of alcohol-dehydrogenase. Prophylactic action against alcoholic embryopathy can be based on persuasion of drinkers to change their drinking habits. Medical termination of pregnancy should be proposed in severe cases of chronic alcoholism.

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As early as about the turn of the century the causes for the discharge of the meconium under labour were studied and the attempt was made to record alterations of the cardiac sound under the influence of labour pain as well as the behaviour of the fetal heart by means of the electrocardiogram. In the development of obstetrics certain stages can be observed which in the past few decades entailed a great many changes, such as changing from delivery at home to delivery at hospital, parasitological clarification of intrauterine infections and the revelation of the pathogenesis of the Mhn. Studies of the physiology of intrauterine respiration, direct measurements of the oxygene pressure in the fetal blood represent the base for the future development of perinatal medicine. An essential improvement of the fetal supervision has come about ever since amnioscopy, cardiotocography, supersonic diagnostics, hormono- and enzyme analyses were introduced. Problems of organization and the future tasks of perinatal medicine are shown on the basis of maternal mortality at district level and perinatal mortality of the hospital.

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In 16 normal and pathologic pregnancies we carried out the dehydroepiandrosterone-sulphate loading test by injection of 50 mg DHEA-S-Na intravenously. The plasma concentrations of unconjugated estradiol and estriol were measured by radioimmun-assay. The level of estradiol increased continuously, rising to a maximum 60 min after the injection. In pre-eclamptic patients and cases of intrauterine growth retardation the rise was significantly reduced. There was a good correlation between result of the test and clinical dates. In plasma concentrations of unconjugated estriol no changes could be observed within 3 hours after the injection.

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